Patients have been left confused by a system that allows anyone with a basic medical degree and registered as a doctor able to call themselves a ''cosmetic surgeon''.

''We have a situation where even dental specialists and anaesthetists are performing invasive procedures like breast augmentation, liposuction and facelifts, even though these people don't have surgical training,'' Dr Hugh Bartholomeusz, a member of the council of the Australian Society of Plastic Surgeons, said.

''Plastic surgeons'' who are members of the society undergo a minimum of seven years of additional training after basic medical training.

Dr Bartholomeusz said that while members of the society were bound by a strict code of practice many ''cosmetic surgeons'' were not surgeons and not able to join the society.

''There is a huge gap allowing unsafe surgery to occur and we need to pin down the federal and state governments to realise something needs to be done urgently,'' he said. ''They have not in any way attacked intravenous operations occurring in unlicensed premises, often without an anaesthetist on hand.''

Fairfax Media revealed this week an investigation by the federal drug regulator into allegedly cheap, unapproved Botox being used at two Ultrasonic slimming clinics in Paddington and Gladesville by Dr Leo van den Heuvel.

The investigation was launched after a complaint by the Australasian College of Cosmetic Surgery.

Dr van den Heuvel has said his product was genuine and he made no profit on the injections.

Some doctors are repeat offenders in harmful cosmetic surgery procedures because court cases against them are settled before they reach a hearing, medical lawyers say.

A medical lawyer with Catherine Henry Partners in Newcastle, Kate Washington, said the firm received a steady stream of clients who had suffered cosmetic harm and did not understand the true level of qualification of their clinicians.

The complaints ranged from simple procedures through to more complex surgeries, she said.

''We also see the same practitioners doing it again and again, which strongly suggests that industry regulation is non-existent,'' Ms Washington said. ''No one is policing them and invariably, when the claim is commenced in court, it is settled, does not proceed to a hearing and the doctor is not held to account. ''

Botched procedures often caused permanent physical scarring and psychological trauma, she said.

Victims included those who had sought breast reconstruction after cancer, burns victims hoping to treat scarring and people with other disfigurements, she said.

''We've seen breast augmentations that end up under people's armpits,'' she said.

''We've seen tummy tucks performed in a manner that would never have achieved the desired outcome, causing deformity and scarring. There are facelifts that cause nerve damage. Then there is a procedure, threading, that is supposed to achieve a facelift but we have seen it instead causing oozing excisions, abscesses and scarring.''

There was a ''complete lack'' of consumer protection, she said.

In 1999, the Health Care Complaints Commission completed an inquiry into the cosmetic surgery industry, but more than a decade later most of the key recommendations had not been implemented, Ms Washington said.

One patient, who cannot be named as she is seeking legal advice, says she suffered infections and scarring after undergoing threading by a surgeon one year ago. It involves permanent sutures being 'threaded' through a hollow guide and barbs planted in the soft tissue of the face.

The patient said she was not told of any possible complications though doctors are required to outline them.

''I was off works for months and months,'' she said. ''I suffered infections and scarring and the stress of it caused severe depression. I was unable to leave the house.''

When she asked the doctor what his plan was to treat her complications, he said he did not have one and she would have to wait it out.

A spokesman for the Australasian College of Cosmetic Surgery, Alan Jones, hit back at the criticisms aired by Dr Bartholomeusz.

''Surgeons, whatever their training, are as capable as any other doctor of behaving unethically or dangerously as myriad … examples show,'' he said.

''The Australasian College of Cosmetic Surgery code of practice is enforceable and enforced.''

He called on both the the Royal Australasian College of Surgeons and the Australian Society of Plastic Surgeons to police unethical or illegal advertising and other practices by their own members.

He added: ''[The] Australian Society of Plastic Surgeons frequently misstates the scope and duration of plastic surgery training.''

Do you know more? mdavey@fairfaxmedia.com.